By Margaret Edmunds, Frank A. Sloan, Committee on Geographic Adjustment Factors in Medicare Payment, Board on Health Care Services, Institute of Medicine

ISBN-10: 030921145X

ISBN-13: 9780309211451

Medicare is the biggest well-being insurer within the usa, offering insurance for 39 million humans elderly sixty five and older and eight million individuals with disabilities, and achieving greater than an anticipated $500 billion in funds in 2010. even though Medicare is a countrywide software, it adjusts fee-for-service funds in keeping with the geographic position of a tradition. whereas there's common contract in regards to the value of supplying actual funds to companies, there's war of words approximately how top to regulate money in response to geographic place. on the request of Congress and the dept of healthiness and Human prone (HHS), the Institute of drugs (IOM) tested how you can enhance the accuracy of information resources and techniques used for making the geographic alterations to funds. The IOM recommends an built-in technique that comes with relocating to a unmarried resource of salary and merits info; altering to 1 set of cost components; and increasing the variety of occupations integrated within the index calculations. the 1st of 2 stories, Geographic Adjustment in Medicare check: section I: bettering Accuracy, assesses latest practices with reference to accuracy, standards consistency, facts for adjustment, sound cause, transparency, and separate coverage changes to reform the present cost process. Adopting the suggestions defined during this document will suggest a metamorphosis within the approach that the indexes are calculated, and should require a mixture of legislative, rule-making, and administrative activities, in addition to a interval of public remark. Geographic Adjustment in Medicare fee will tell the paintings of presidency corporations akin to HHS, the facilities for Medicare and Medicaid providers, congressional contributors and employees, the wellbeing and fitness care undefined, nationwide specialist corporations and kingdom scientific and nursing societies, and Medicare advocacy teams.

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Geographic Adjustment in Medicare Payment: Phase I: by Margaret Edmunds, Frank A. Sloan, Committee on Geographic PDF

Medicare is the most important well-being insurer within the usa, offering insurance for 39 million humans elderly sixty five and older and eight million individuals with disabilities, and achieving greater than an envisioned $500 billion in funds in 2010. even though Medicare is a countrywide application, it adjusts fee-for-service funds in keeping with the geographic place of a tradition.

Extra info for Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition

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Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition S-6 GEOGRAPHIC ADJUSTMENT IN MEDICARE PAYMENT employment settings may not be identical according to their training and scope of service. In developing recommendations about data sources for the HWI and GPCIs, committee members compared an independent source of wage data for all-industry, health care sector, and hospital-specific wages for several occupational categories and found a very high degree of correlation between health care sector wages and wages from the other two sectors.

Although Medicare is a national program, policy makers and researchers working to develop and implement its payment systems have long recognized that health care delivery is local, and that payment amounts must be adjusted to reflect input price differences across geographic areas of the United States. The two geographic adjustments applied to Medicare payments for care provided by hospitals and practitioners are the hospital wage index (HWI) and three geographic practice cost indexes (GPCIs). In broad terms, an index compares differences in price or quantity for a group of goods and services relative to an average value derived from a standard baseline geographic area or time period (see Box 1-1).

It explains the three GPCI components: physician work; practice expense, including employee wages and rent; and professional liability, or malpractice insurance. The chapter also reviews concerns about the accuracy and appropriateness of the methods and sources of data used to calculate the GPCIs that stakeholders have expressed. After reviewing several sources of data for each GPCI component and discussing the ways in which the GPCIs are calculated, the committee made seven recommendations regarding national cost share weights; a full range of occupations in the practice expense component; geographic adjustment for certain non-clinical laborrelated expenses; new data sources for office staff wages and office rent; and a new method for setting the work adjustment.

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Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, Second Edition by Margaret Edmunds, Frank A. Sloan, Committee on Geographic Adjustment Factors in Medicare Payment, Board on Health Care Services, Institute of Medicine


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